| NPI | 1427281831 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: WV 1987) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC NA) |
| 363AS0400X Physician Assistant, Surgical (Licence: NC NA) | |
| Enumeration Date | 2009-09-01 |
| Last Update Date | 2016-07-28 |